Alternative Approaches to Characterizing Disparate Care by Race, Ethnicity, and Insurance Between Hospitals

Alina Kung (), Yingtong Chen, Bian Liu, Louisa W. Holaday, Karen McKendrick and Albert L. Siu
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Alina Kung: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
Yingtong Chen: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
Bian Liu: Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
Louisa W. Holaday: Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
Karen McKendrick: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
Albert L. Siu: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

IJERPH, 2025, vol. 22, issue 10, 1-21

Abstract: Identifying hospitals that disproportionately serve minority and publicly insured patients is important because patients at these hospitals often experience worse outcomes. Studies commonly identify disproportion by using the top decile of hospitals with the greatest proportion of Black discharges nationally. Our study aimed to identify a broader measure that accounts for disproportion by multiple characteristics. Using fee-for-service Medicare data, we classified hospitals as either serving disproportionately or not, examined overlaps in classification, and assessed differences in hospital quality. We found that using a combined measure for any hospitals in the top decile or above a threshold of twice their local healthcare market average of Black, Hispanic, minority, or dual-eligible discharges classified 28.1% ( n = 680/2420) of hospitals as serving disproportionately, compared to only 10% ( n = 242/2420) when using the top decile of a single characteristic. The combined measure detected moderate differences in hospital star quality ratings (mean difference of 0.57–0.87, all p -values < 0.001; standardized mean difference: 0.50–0.79, 95% CIs all above 0). The combined measure identified hospitals that were smaller, more rural, and served other minorities, namely, Asian and American Indian populations. Future work should consider using this combined measure to more comprehensively identify hospitals that disproportionately serve minority or publicly insured patients.

Keywords: hospitals; Medicare; Medicaid; racial groups; ethnicity; minority health; socioeconomic disparities in health; healthcare disparities (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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